Objective To discuss the clinical effects of external fixator combined with limited internal fixation in treatment of serious comminuted distal radius fractures. Methods 35 patients with serious comminuted distal radius fractures were treated by external fixator combined with limited internal fixation from January 2001 to May 2004. There were 16 males and 9 females with an average age of 47.3 years. According to AO/ASIF classification, 9 fractures were A3 type, 9 C2, and 17 C3. Reduction was achieved and maintained in 27 cases by longitudinal traction and external fixation, 5 by external fixator with percutaneous K-wire, and 3 by external fixatator combined with ulnar limited internal fixation. Results All the patients were followed up from 5 months to 30 months (12 months on average). According to the anatomical alignment, 9 were excellent, 24 good, and 2 fair. It was necessary to restore the anatomy of distal radius both on sagittal and coronal planes in order to obtain good functions. Preoperatively, the radial inclination angle was -15? to 15?(10.5? on average), and the palmar tilt angle was -30? to 0?(-10? on average). After operation, the two angels were reduced to 20? to 35?(25? on average), and 0? to 20?(11.5? on average)respectively. The joint function was assessed by Dienst criteria, the results suggested that 12 were graded as excellent, 21 good, and 2 fair. No severe complications were found. Conclusion The treatment of serious comminuted distal radius fractures using external fixator combined with limited internal fixation is of easy performance, reliable fixation, satisfactory effect, and lower complications. It offers a new method which can obviously improve the union of the fractures and decrease the infection rate postoperatively for the treatment of the fractures of distal radius.

BACKGROUND:Femoral shaft fracture is common in children Various methods of treatment can be used successfully,depending On the age of the child and the type of fracture.OBJECTIVE:To evaluate the feasibility of adult reconstruction plate of humeral shaft for pediatric femoral shaft fracture.METHODS:A total of 32 children with femoral shaft fracture were treated with adult reconstruction plate of humeral shaft in First Department of Orthopedics,Fuzhou General Hospital of Fujian Medical University,including 20 males and 12 females aged 6.7years(5-8 years).All patients were treated with incision reduction and adult reconstruction plate of humeral shaft.The incision length should be made as short as possible according to the fracture type The result of surgery was determined using clinical and radiographic examinations The pain condition was evaluated using visual analog scale method before and 3 days following surgery.RESULTS AND CONCLUSION:The patients were followed up for 1-2 years(average 1.5 years).All fractures were healed 1-2months postoperatively,and the internal fixator was removed 4-8 months postoperatively.The affected limb was shortened0.6-1.5 cm(average 1.1 cm)in 3 cases.Overgrowth was obsewed in the other patients by 0.3-1.2 cm The average overgrowth length was(0.64±0.312)cm in 29 patients.At 3 days postoperatiVely,the mean subjective pain was significantly reduced,and range of motion was improved compared with the day before surgery There was no infection or implant displacement or re-fracture.It is feasible to use adult reconstruction plate of humeral shaft for paediatric femoral shaft fracture.

Objective To explore the incidence of tibial plateau fracture with ligament injuries and the early diagnosis and management of the condition. Methods Fifty seven cases of tibial plateau fractures which had been treated operatively from Jan. 2001 to Jun.2003 and had satisfactory reduction of the articular surface were reviewed. The stability of their knee joints was analyzed. Results The follow up lasted 6 to 30 months with an average of 15 months. The incidence of knee unstability was low. The four potential reasons for the postoperative knee stability were found to be: 1) the low prevalence of ligament injury with displaced fractures of tibial plateau; 2) incomplete ligament disruption or mild ligament injury; 3) anatomic reduction and rigid internal fixation; 4) fine and detailed plan for immobilization and functional exercise. Conclusion The prevalence of complete ligament disruption is low, and nonoperative management can result in satisfactory outcomes for tibial plateau fracture with incomplete ligament injury.

Objective To analyze the causes of postoperative step off of the tibial plateau fracture and to suggest strategies to cope with them. Methods 57 cases of tibial plateau fracture who had been treated operatively in our department from January 2001 to June 2003 with satisfactory reduction of the articular surface were reviewed. Their radiograms were analyzed. Results The follow ups lasted 6 to 30 months (average 15 months). Postoperative step off rate was 28.1%in all the cases according to radiological step off criteria. (A depression of the articular surface more than 3 millimeters or malalignment of the extremity more than 5 degrees is considered as step off.). Six causes of loss of reduction were: 1) more than sixty years of age, 2) severe osteoporosis, 3) preoperative displacement and fracture fragmentation, 4) poor anti shearing strength of screw and plate, 5) loose bonegraft, and 6) premature weight bearing. Conclusions The key points to enhance the outcome include precise judgment of the type of fracture, sufficient amount of bonegraft, rigid internal fixation after anatomic reduction and an appropriate plan for performing early, loadless, functional exercise. The traumatic osteoarthritis may be avoided or deferred if the above mentioned six causes can be taken into full consideration or preventive measures can be taken.